"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

February 21, 2014

Coping with infectious disease

Thanks to Krisztian Magori for retweeting a tweet from Peter Vikesland linking to this New York Times editorial: Coping With Infectious Disease. Excerpt:

The list of infectious diseases that could leap from remote areas of the world to strike countries thousands of miles away is growing. A warning of what can happen occurred a decade ago when an outbreak in China of a mysterious new viral disease, known as SARS, or severe acute respiratory syndrome, was covered up by the Chinese authorities, allowing infected airline passengers to carry the virus to more than two dozen other countries. The disease killed nearly 800 people and caused large economic losses in Asia and Canada.

Now longstanding worries that such deadly viruses as Ebola might be carried from Africa to the United States and elsewhere have been joined by new concerns. These include, among others: potentially dangerous strains of avian flu recently detected in China; a newly discovered and often lethal lung disease, known as Middle East respiratory syndrome, or MERS, which has so far been found mostly in Saudi Arabia; multidrug-resistant strains of tuberculosis that are very difficult to treat; and a painful mosquito-borne viral disease known as Chikungunya fever, which was first detected in Africa, spread to Asia and Europe, and recently invaded the Caribbean.

Beyond these natural threats lurk man-made threats, such as biological weapons that could kill millions and the danger that deadly pathogens being studied in laboratories might escape confinement or be deliberately released to set off a pandemic.

It made good sense, then, when the Obama administration, after meeting with representatives of three United Nations agencies and 26 countries last week, announced an ambitious plan to improve the surveillance and treatment of infectious diseases over the next five years in up to 30 countries.

There is much to be done. Although 196 countries have signed an international agreement, reached in 2005, to report outbreaks promptly to the World Health Organization and take steps to control them, the vast majority have not fully complied. The odds for improvement this time around may be better. The health systems in poor countries, though still fragile, have improved thanks to international programs to combat AIDS and other diseases, and those systems could be expanded.

A pilot project in Uganda last year, supported by the Centers for Disease Control and Prevention, showed that biological specimens from sick patients could be gathered in remote areas of the country and carried by motorcycle and overnight delivery service to a well-equipped central laboratory, and the test results could be transmitted back by cellphone to the remote areas. A new technology currently being tested in Uganda is a dipstick, like those used for pregnancy tests, that can diagnose pneumonic and bubonic plague at the patient’s bedside in 20 minutes.

Well, fine, I guess. But once you've phoned in your pneumonic-plague diagnosis, how long do you wait for effective help? And how much longer do you wait before some rich country finds the money to exterminate the local rats carrying Yersinia pestis? Madagascar's been waiting for years.

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Coping with infectious disease

Thanks to Krisztian Magori for retweeting a tweet from Peter Vikesland linking to this New York Times editorial: Coping With Infectious Disease. Excerpt:

The list of infectious diseases that could leap from remote areas of the world to strike countries thousands of miles away is growing. A warning of what can happen occurred a decade ago when an outbreak in China of a mysterious new viral disease, known as SARS, or severe acute respiratory syndrome, was covered up by the Chinese authorities, allowing infected airline passengers to carry the virus to more than two dozen other countries. The disease killed nearly 800 people and caused large economic losses in Asia and Canada.

Now longstanding worries that such deadly viruses as Ebola might be carried from Africa to the United States and elsewhere have been joined by new concerns. These include, among others: potentially dangerous strains of avian flu recently detected in China; a newly discovered and often lethal lung disease, known as Middle East respiratory syndrome, or MERS, which has so far been found mostly in Saudi Arabia; multidrug-resistant strains of tuberculosis that are very difficult to treat; and a painful mosquito-borne viral disease known as Chikungunya fever, which was first detected in Africa, spread to Asia and Europe, and recently invaded the Caribbean.

Beyond these natural threats lurk man-made threats, such as biological weapons that could kill millions and the danger that deadly pathogens being studied in laboratories might escape confinement or be deliberately released to set off a pandemic.

It made good sense, then, when the Obama administration, after meeting with representatives of three United Nations agencies and 26 countries last week, announced an ambitious plan to improve the surveillance and treatment of infectious diseases over the next five years in up to 30 countries.

There is much to be done. Although 196 countries have signed an international agreement, reached in 2005, to report outbreaks promptly to the World Health Organization and take steps to control them, the vast majority have not fully complied. The odds for improvement this time around may be better. The health systems in poor countries, though still fragile, have improved thanks to international programs to combat AIDS and other diseases, and those systems could be expanded.

A pilot project in Uganda last year, supported by the Centers for Disease Control and Prevention, showed that biological specimens from sick patients could be gathered in remote areas of the country and carried by motorcycle and overnight delivery service to a well-equipped central laboratory, and the test results could be transmitted back by cellphone to the remote areas. A new technology currently being tested in Uganda is a dipstick, like those used for pregnancy tests, that can diagnose pneumonic and bubonic plague at the patient’s bedside in 20 minutes.

Well, fine, I guess. But once you've phoned in your pneumonic-plague diagnosis, how long do you wait for effective help? And how much longer do you wait before some rich country finds the money to exterminate the local rats carrying Yersinia pestis? Madagascar's been waiting for years.